Inadequate drug prescription and the rise in drug-induced acute tubulointerstitial nephritis incidence

Drugs are a frequent cause of acute tubulointerstitial nephritis (ATIN). Antibiotics, non-steroidal anti-inflammatory drugs and recently proton pump inhibitors stand among the most commonly responsible ones. However, their respective responsibility is not well known. This study reports 33 cases of drug-induced ATIN (DI-ATIN), the most frequent ones being metamizole and omeprazole. Clinicians often fail to diagnose DI-ATIN because its signs and symptoms are non-specific and differ from the now classic form observed with methicillin. Furthermore, drugs causing ATIN are too often prescribed unnecessarily. This study shows that in more than one-fifth of our cases, ATIN complicated prescription of a drug that was not justified by an adequate clinical indication. The consequences were noxious for the patients and costly in terms of public health expenses.